Impact of chronic pain on health care seeking, self care, and medication. Results from a population-based Swedish study

Study objective-To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in a n unselected population. Design-A mailed survey with questions about pain and mental symptoms, disab ility, self care action, visits to health care providers, and medication. Setting-General populations in two Swedish primary health care (PHC) distri cts. Medical care was given in a state health system. Participants-A random sample (from the population register) of 15% of the p opulation aged 25-74 (n = 1806). Main results-Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p<0.05) consulted a physician and 7.2% (compar ed with 1.2%, p<0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depr ession, ethnicity, and socioeconomic level had the greatest impact on physi cian consultations. Alternative care, used by 5.9%, was associated with hig h pain intensity and self care. Use of self care was influenced by high pai n intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women repor ting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consu ltation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self ca re action, visit to an alternative therapist, high pain intensity, and soci oeconomic level. Conclusions-The presence of chronic pain has an impressive impact on primar y health care and medication. Various therapeutic actions are common and ar e partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also aff ected by ethnicity, age, socioeconomic level, and depressive symptoms. Amon g people with chronic pain use of analgesics is common in contrast with oth er types of pain relief (acupuncture, physiotherapy) suitable treating chro nic pain symptoms.